III. Epidemiology

  1. Peak ages: 6-18 months
  2. Very common
    1. Prevalence of Antibody to HHV-6 approaches 100% by 3 years of age

IV. Signs

  1. Days 1-2
    1. Anorexia
    2. Vomiting
    3. Diarrhea (variable)
    4. Mild cough or Rhinorrhea (variable)
    5. Occipital Lymphadenopathy
  2. Days 2-3
    1. High Fever starts (103 to 106 F)
      1. Occurs at onset without accompanying localizing signs
      2. Fever Without Focus
        1. Often a diagnostic dilemma until the rash appears
        2. Child appears well without focal findings
        3. Mild cough or Rhinorrhea may be present
        4. Mild Diarrhea may be present
  3. Day 4
    1. Rash onset as fever abates
      1. Fine, erythematous or pink Macules and Papules (maculopapular rash)
      2. Pink, blanchable, almond shaped Macules
      3. Most common centrally on the trunk and neck (may spread peripherally to extremities)
      4. Macules become confluent with one another and then fade within hours to 2 days
    2. Other associated findings
      1. Viral Sialoadenitis (especially Parotid Gland)

V. Differential Diagnosis

  1. See Fever Without Focus
  2. Rubeola (Measles)
    1. Rash in Measles starts on face (especially behind ears) and spreads inferiorly
    2. Children with Measles appear ill (contrast with normal appearance in Roseola)

VI. Complications

  1. Febrile Seizures (common cause)

VII. Management

  1. Symptomatic
  2. Tylenol or Ibuprofen for fever

VIII. References

  1. Latessa (2012) AAFP Board Review Express, San Jose
  2. Allmon (2015) Am Fam Physician 92(3): 211-6 [PubMed]

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Ontology: Exanthema Subitum (C0015231)

Definition (MSH) An acute, short-lived, viral disease of infants and young children characterized by a high fever at onset that drops to normal after 3-4 days and the concomitant appearance of a macular or maculopapular rash that appears first on the trunk and then spreads to other areas. It is the sixth of the classical exanthematous diseases and is caused by HHV-6; (HERPESVIRUS 6, HUMAN). (From Dorland, 27th ed)
Concepts Disease or Syndrome (T047)
MSH D005077
ICD9 058.10, 058.1
ICD10 B08.2 , B08.20
SnomedCT 154344005, 266193008, 240559001, 154343004, 266192003, 54385001, 402902002
English Exanthema Subitum, Roseola Infantum, Sixth Disease, Disease, Sixth, Roseola, Exanthema subitum [sixth disease], SIXTH DIS, Roseola infantum, unspecified, Sixth disease, unspecified, Exanthema subitum, unspecified, roseola infantum, roseola infantum (diagnosis), Roseola infantum NOS, Exanthema subitum [sixth disease], unspecified, Exanthema Subitum [Disease/Finding], infantum roseola, disease sixth, three day fever, exanthem subitum, exanthema subitum, subitum exanthema, roseola, Roseola (disorder), Exanthema subitum, Roseola infantum, Sixth disease, Pseudorubella, Three day fever, Exanthem subitum, Exanthema subitum (disorder), disease (or disorder); sixth disease, exanthema; subitum, fever; three-day, infantum; roseola, pseudorubella, roseola; infantum, sixth disease, subitum; exanthem, three-day; fever
Dutch exanthema subitum, roseola infantum, zesde ziekte, aandoening; zesde ziekte, driedaagse; koorts, exantheem; subitum, infantum; roseola, koorts; driedaagse, roseola; infantum, subitum; exantheem, Exanthema subitum [zesde ziekte], roseola, Exanthema subitum, Roseola infantum, Zesde ziekte
Italian Eritema maculare, Exantema subitum, Sesta malattia dell'infanzia, Roseola infantum, Sesta malattia
Portuguese Exantema súbito, Sexta doença, Roséola, Exantema Súbito, Roséola Infantil, Sexta Doença
Spanish Exantema súbito, Roseola infantil, Sexta enfermedad, roséola, roséola (trastorno), exantema súbito (trastorno), exantema súbito, pseudorrubéola, roséola infantil, seudorrubéola, sexta enfermedad, Roseola, Exantema Súbito, Roseola Infantil, Sexta Enfermedad
French Roséole du nourrisson, 6e maladie, Roséole, Exanthème critique, Exanthème subit, Roséole infantile, Sixième maladie, 6ème maladie, Fièvre des 3 jours, Fièvre des trois jours, Maladie de Dukes-Filatov
German sechste Krankheit, Exanthema subitum [Sechste Krankheit], Roseola, Exanthema subitum, Roseola infantum, Sechste Krankheit, Dreitagefieber
Japanese ばら疹, 第6病, ショウニバラシン, バラシン, ダイ6ビョウ, トッパツセイホッシン, トッパツセイハッシン, ザホルスキー病, 発疹-突発性, 小児ばら疹, 小児バラ疹, 小児薔薇疹, 特発性ほっ疹, 特発性発疹, 突発性ほっ疹, 突発性発疹, 第6病, 第六病, 薔薇疹-小児, バラ疹-小児, 突発性発疹症
Swedish Tredagarsfeber
Czech exanthema subitum, Rozeola, Roseola infantum, Exanthema subitum, Šestá nemoc, 6. dětská nemoc, roseola infantum, šestá dětská nemoc, dětská růžovka, rychlá vyrážka, třídenní horečka, šestá nemoc
Finnish Vauvarokko
Korean 돌발 발진 [제6병]
Polish Rumień nagły, Choroba szósta, Wysypka nagła
Hungarian Roseola infantum, roseola, exanthema subitum, Hatodik betegség
Norwegian 6. barnesykdom, Fjerde barnesykdom, Roseola infantum, Tredagersfeber, Exanthema subitum, 4. barnesykdom, Sjette barnesykdom